Our Provider Services team engages with medical providers to offer dedicated health care services and to provide resources for managing a patient’s health care needs. A valuable provider resource is the Cigna for Health Care Professionals website (CignaforHCP.com).

Providers can access this website to find a variety of information and perform transactional activities, such as:

• Check patient eligibility.
• Verify claims, payments, and fee schedules.
• Update Cigna Healthcare provider directory information.
• Find forms for authorizations, referrals, and filing or appealing claims.
• Review Cigna Healthcare coverage policies.
• Retrieve reimbursement and payment information (appeal policies, claim editing procedures, etc.).
• Learn about the precertification process.
• Get questions answered in the resource library.
• Join the Cigna Healthcare medical network.
• Join interactive, web-based demonstrations of CignaforHCP.com, including an overview of the website; eligibility and benefits; how to check claim status; online appeals and claim reconsiderations; electronic funds transfer, online remittance, and how to request a fee schedule; and website access manager training.

Providers who are not yet registered for the website can go to CignaforHCP.com > Register.

In addition, there are several other resources available to providers:

• Cigna Healthcare provider directory.
• Credentialing information for behavioral and dental.
• Cultural Competency and Health Equity Resources.
• Newsletters: medical, dental, and behavioral.
• Registration for Technical Assistance Portal, which offers training opportunities related to the ACA.
• Quality Rating System information.

When providers learn more about our available programs and incentives, they can better promote the vitality and well-being of their patients. We partner with providers to help them encourage patients to take control of their preventive and health care needs and to educate them on Cigna Take Control Rewards^® and virtual care.

Take Control Rewards

Our subscribers who are 18 years of age or older can complete healthy behaviors/activities (e.g., watching a short video, reading a flyer, taking a brief quiz) to earn reward points that they can redeem for merchandise, travel, entertainment, or a Reloadable Reward Card. Customers can earn up to 3,250 points ($325 worth of rewards).

For more information about Take Control Rewards, customers should call the toll-free number on the back of their Cigna Healthcare ID card.

Virtual care

Our customers have access to medical and behavioral health care 24 hours a day, 365 days a year via MDLIVE^®, a national virtual care provider. Our customers can access MDLive via the myCigna^® App or myCigna.com^® when their preferred provider is not available (such as after hours or on weekends).^*

^* Individuals should review their benefits and eligibility prior to being seen by an MDLIVE provider.

Express Scripts Pharmacy Home Delivery

• Pharmacy: Submit electronically to Express Scripts Home Delivery via:
• Electronically (fastest service): Express Scripts Home Delivery, NCPDP 2623735, or
• Fax: Call 888.327.9791 to obtain a fax order form

Resources for customers

• MyCigna.com: Customers can create an account to find care and costs, view claims, manage spending accounts, and access their digital ID cards.
• Pharmacy:
• Website: https://www.cigna.com/individuals-families/member-guide/home-delivery-pharmacy
• Call 1-800-835-3784
• CignaCommunity.FindHelp.com: Customers can enter their ZIP code to search for local social services. Give your patients this resource flyer for more information about FindHelp.

• Quality Rating System information
• Recommended minimum documentation
• QRS Quick Reference Guide
• What is HEDIS?

The IFP Risk Adjustment Provider Education team supports provider organizations by offering a range of educational resources to encourage compliance in diagnosis coding and medical documentation, as well as timely and complete claims submission. Below are links to disease-specific educational flyers to assist providers in coding and documentation improvement.

Note: Information on this web page does not replace International Classification of Diseases, 10th Revision (ICD-10) coding guidelines and conventions or a provider’s clinical judgment when caring for a patient. Many chronic conditions persist and require active treatment but should not be documented if they have resolved. If conditions are found to have been misidentified, providers should notify the IFP Risk Adjustment Provider Education team at CignaHealthcareHCPEducation@CignaHealthcare.com.

Coding educational flyers

• Alcohol Use Disorder
• Atrial Fibrillation
• Cancer
• Chronic Kidney Disease
• Congestive Heart Failure
• Chronic Obstructive Pulmonary Disease
• Diabetes
• Hypertension
• Major Depressive Disorder
• Risk Adjustment Coding
• Seizure Disorders
• Social Determinants of Health
• Status Codes

Other resources

In addition to the flyers, there are other resources available to providers:

• The Centers for Medicare & Medicaid Services (CMS) website has more information about ICD-10 resources, including common ICD-10 codes, clinical documentation tips, and clinical scenarios.
• Providers can log in to CignaforHCP.com to view the status of their claims. The explanation of payment will display the outcome of the claim processing (e.g., what was paid, what the patient owes, what isn’t covered). Note: Provider claim submissions must be fully adjudicated (Cigna Healthcare will review and decide whether the claim will be fully or partially paid or denied).

For questions about provider education for Cigna Healthcare IFPs, providers may contact IFP Risk Adjustment Operations at CignaHealthcareHCPEducation@CignaHealthcare.com.

Chart retrieval provider notification sample letter: This document is a sample of the provider notification letter identifying the customer medical record charts requested for the RVP and RADV timeframes.

Chart retrieval typical time frames

Chart retrieval supplier partners for Cigna IFP plans
CIOX
MRO/MediCopy
MOXE
ShareCare

Chart retrieval transmission
Below are the email and fax line:
    Please send the records via our secured fax number at 1.855.838.6833,
    Or you may send via email at CignaHealthcareHCP@CignaHealthcare.com